6 Reasons Why Nurses are the Unsung Heroes of the ER

During a busy Sunday evening in my ER two weeks ago, while I stitched closed a laceration to the temple of a two-year-old infant who had run into a door, disaster struck. As is customary in these situations, my attendant nurse, a kind woman who is wonderful with children, had wrapped up the child in layers of sheets to prevent any unexpected movements of arms or legs while we performed the delicate procedure. Halfway through my sewing, our young patient stealthily managed to extricate a right arm from her wrapping, and promptly, before anyone noticed, the injured child delivered a full force punch to the face of my poor nurse.

The nurse assisting me rapidly developed a substantial bruise near her eye (believe me -- injured babies throw a mean punch!), but she never flinched, proceeding to calmly re-wrap the offending arm, and allowing me to finish suturing. Afterwards, to my chagrin, the parents of the injured baby ignored the nurse and the injuries she had sustained in order to help their child, while proceeding to thank me profusely for my care.

This episode got me thinking -- our nurses so frequently go above and beyond the call of duty, while receiving so little recognition for their amazing work and dedication. It is a situation I feel we all should do our best to improve, so without further ado, the top reasons why nurses are my true heroes of the Emergency Room:

1) Nurses regularly save us doctors when the going gets tough

Almost every doctor out there has stories, from their years in practice, about how an experienced nurse saved the day for them at some point. For me, the first time this occurred was during my residency, prior to receiving my license to practice.

I remember, during a night on call, seeing an older male patient who presented with suddenly elevated blood pressure and difficulty breathing -- the type of critically ill patient I would have seen only with a senior physician by my side during daytime hours. Being alone with this dying man, no other MD in sight, I froze, suddenly unable to recognize the clear diagnosis -- acute congestive heart failure -- that was in front of me.

As I watched my patient slipping away from me, rapidly running out of strength to breathe further, I felt a tap on my shoulder. It was one of the experienced nurses on the floor, a knowledgeable pro who had seen it all. She said to me gently, "I see you're here for the heart failure patient -- want me to draw up drugs x, y, and z?" Her quick, attentive action saved the day. With the correct diagnosis identified, and proper treatment started, the patient quickly improved. I learned a lesson that day, one that I have never forgotten: that nurses know their stuff, and that their enormous experience is an incredible asset to have by my side when faced with the most challenging patients.

2) Nurses take abuse and maintain their professionalism

Emergency rooms, due to the high-pressure, life and death nature of the work we perform, are very stressful places to be. Patients and their family members, as well as hospital staff, are frequently on edge. When tempers flare in the ER, nurses, as the workers in the ER who spend the most time with patients, frequently serve as proverbial, and all too often literal, punching bags.

In the course of my career I have repeatedly seen nurses assaulted by intoxicated, demented, and mentally ill patients, as well as verbally abused by patients and families upset with wait times and outcomes. A 2005 study found that 34 per cent of hospital nurses reported a direct physical assault from a patient within the past year. Despite this, I have observed nurses almost always maintaining their cool and remaining professional, even in the face of events that would result in police being called to almost any other workplace.

3) Nurses do all the dirty work that doctors don't

There is nothing pretty or glamorous about much of the work performed in a typical emergency room. Throughout a shift, countless tasks need to be completed that would curdle the stomach of any but the most hardened individuals. From diaper changes on elderly patients, to administering enemas, to cleaning bed bugs and maggots off of our homeless and less fortunate guests, the nurses I work with do it all, and it is a testament to their dedication that they rarely protest about it. In fact, I am constantly amazed at how gentle and kind they are with the patients whose illnesses require such unpalatable care.

4) Nurses work gruelling hours

The average ER nursing shift is 12 hours long, and usually starts at either 7:30 a.m., or 7:30 p.m. Most nurses work a staggered schedule of several day shifts, then several night shifts, followed by several days off. As a result, their bodies are perpetually in a state of shifting time zones and sleep schedules, with constant exhaustion as a consequence. Long-term, these types of shift work schedules can raise a nurse's risk of cardiovascular disease by 40 per cent and diabetes by 50 per cent -- a huge price to pay in personal health for one's profession.

Additionally, nursing schedules have little regard for social lives, family obligations or holidays. Without exception, the ER nurses I know regularly work Christmas days, New Year's Eves, Passovers, and the like. Wonderfully, instead of complaining about this, nurses in my department throw potluck meals during holidays and adorn the ER with impressive festive decorations, transforming a place nobody wants to be during these special days into a celebratory place for patients and staff.

5) Nurses get to know their patients better than any ER doctor can

During an average ER shift, I see a bare minimum of 30 patients, and on my busiest days, over 50 patients. This leaves me little opportunity to get to know my patients, answer their questions, or allay their concerns in any meaningful way. The nurses in my department typically get to spend time with patients both before and after I see them, explaining the tests I order, the diagnoses I come up with, and the treatments needed. The soothing, compassionate presence of my nurses, and the extra time they provide to patients, allows the people we care for to be properly informed about their illnesses, and to feel individually tended to, in a way that ER physicians only wish they could achieve.

6) Nurses are educated professionals with unique skill sets

Nursing requires an extensive knowledge base, and in today's hospitals all nurses are required to have either a college or university degree in their field. Additionally nurses are proficient in a wide array of clinical skills that are absolutely essential to the patients in any ER. When it comes to starting an intravenous line, drawing bloods, administering an electrocardiogram, and a wide variety of other tasks, the nurses I've worked with have unique skills that put mine to shame. In fact, I pity any patient that has their intravenous started by me instead of by a nurse!

So next time you or a family member are sick and end up in the ER, remember who the unsung heroes of the department are, and thank them for all that they go through and all that they do -- I promise they'll appreciate it deeply.

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Brief History of Female Nurses in the Military, from the American Revolution to World War II

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During the Civil War, women, like Annie Bell who nursed soldiers after the Battle of Nashville in 1864, tended to troops without any formal training and often despite resistance from male colleagues. Though some women volunteered through relief organizations, more than three thousand nurses, including African-American women who were former slaves, served under Dorothea Dix, the first Superintendent of Women Nurses for the Union Army.
Photo: Courtesy of U.S. Army Center of Military History

Soon after the Spanish-American War broke out in April 1898, Congress approved the Surgeon General’s request for contract nurses, including those who served on the hospital ship Relief. As in previous wars, more men died from disease than wounds from the enemy, and the country was unprepared to handle the overwhelming number of soldiers suffering from illness. The nurses were eventually selected by Dr. Anita Newcomb McGee, Vice President of the National Society of the Daughters of the American Revolution. Between l898 and l90l, more than l,500 women served the military.
Credit: Courtesy of Naval History & Heritage Command Collection, NH 92846

Nurses were at great risk from getting sick from their patients, including those who served in operating rooms, iat the First Reserve Hospital in Manila, Philippines. During this time, fifteen nurses died from typhoid fever and one from yellow fever. Some of these heroic women are buried near the Spanish-American Nurses War Monument in the Nurses section at Arlington National Cemetery.
Credit: Courtesy of U.S. Army Medical Department

A year after Congress established the all-female Army Nurse Corps in 1901, the Navy's Surgeon-General proposed a similar Navy Nurse Corps. In 1907, still seeking approval, he reported to Congress that, "The Government supplies physicians and surgeons, splendidly equipped hospitals, and complete emergency facilities on every ship. The most serious omission in this excellent establishment is the want of that skilled nursing which civil institutions enjoy.” In May 1908, the Navy Nurse Corps was approved, and the first twenty Navy nurses were appointed.
This photo of the group, known as the Sacred Twenty, was taken at the Naval Hospital in Washington, D.C., around October 1908.
Credit: Courtesy of U.S. Naval Historical Center, NH 52960

To help meet the demand for nurses during World War I, Vassar College started the Vassar Training Camp for Nurses in 1918, which prepared college graduates in a three-month intensive training program to complete nursing school in two years instead of three.
In its recruitment pamphlet, the camp warned that only those committed should apply, "We shall assume at the outset that you are not simply a dabbler or a sentimental dreamer, but a serious, practical, patriotic girl or woman sincerely anxious to throw your energies and your abilities into some form of work that is really going to count." During its first summer, the camp included faculty from Harvard, New York University, Yale, Johns Hopkins, and Columbia as well as students from 41 states and more than a hundred educational institutes.
Other universities soon offered similar programs, while the Army created its own three-year School of Nursing at Walter Reed Hospital, in Washington, D.C. By the end of the war, more than 22,000 nurses, including women working in the operating room at Base Hospital #52 in Haute Marne, France, had served in the military.
Credit: Courtesy of U.S. Army Medical Department

The nurses who remained in the military after World War I lobbied for full military status, arguing that they too had risked their lives for their country and deserved the benefits and authority that came with rank.
In 1920, the Army Reorganization Act awarded Army nurses relative rank in the grades of Second Lieutenant to Major. Though it gave nurses the status of officers and allowed them to wear the insignia of their ranks, nurses’ pay was about half that of male officers of the same rank. It wasn’t until June 1944, more than two years after America entered World War II and months after stranded Army Air Forces flight nurses returned from walking more than 600 miles behind Nazi lines, that the Army granted nurses temporary officers’ commissions with equal pay, retirement benefits, and dependents’ allowances.
Credit: 15th Air Force [USAAF] photo courtesy of Air Force Historical Research Agency, Roll A6544

Despite elaborate efforts to add nurses to its ranks during World War II, including a government-subsidized program that prepared nurses as quickly as possible for duty, the Army Nurse Corps was reluctant to add African-American nurses. Though they had served in the Civil War and 18 had joined the Army Nurse Corps during the nursing shortage in World War I, segregation and discrimination kept the number of African-American nurses to a minimum.
Out of 59,000 Army nurses, only an estimated 600 African-American were allowed to serve, including nurses who prepared to land in Greenock, Scotland, in August 1944. The Navy Nurse Corps didn’t accept its first African-American nurse, Phyllis Mae Dailey, until March 1945. By the time the war ended, only four were on active duty.
Credit: Courtesy of U.S. Army Medical Department

The dangers faced by military nurses serving overseas were quickly realized within months of the United States entering the war. In the spring of 1942 dozens of American nurses became Japanese prisoners of war as Bataan and Corregidor fell in the Philippines.
Though they remained POWs under horrific conditions for three years and suffered their own injuries and illnesses, they continued to care for soldiers in the camp until they were freed in February 1945. In November 1942, 60 unarmed Army nurses found themselves in the thick of combat with troops on beaches during the invasion of North Africa. It was the Allies first amphibious landing in the Mediterranean, and they had expected minimal resistance. Loaded with full packs and wearing helmets, the nurses ducked from sniper fire as they waded to the shore from assault boats.
The service and heroism of all the women who served in the Army and Navy Nurse Corps was finally recognized in 1947 when the temporary officer status granted to them during the war was made permanent.
Photo credit: U.S. Army Center of Military History